The general aim of this project is to attempt to improve the prognosis of patients with cerebrovascular disease. This will be done by evaluating in a randomized double-blind study the effect of intensive care of the acute stroke. The management of the patient will be guided by clinical, angiographic, regional cerebral blood flow and cerebral metabolic data. Regional cerebral blood flow will be determined by a non-invasive inhalation technique which will allow serial determinations to be made. This will enable various therapeutic regimens to be individualized by observing the cerebral blood flow response in that patient. Regimens that improve flow will be maintained while those that don't in a given patient will be changed. These studies will be performed in conjunction with cerebral angiography, which will include magnification and tomographic studies in addition to routine angiography, so that the anatomic and pathologic basis of any abnormalities detected will be known and therapy guided accordingly. The data collected in these studies will also be correlated with neuropathologic studies of the brains of those patients that come to autopsy. These will include microangiographic studies as well as histopathologic preparations. An important concurrent aim of this proposal will be the teaching of house staff and medical students so as to disseminate the latest information concerning cerebrovascular disease and to arouse their interest in these problems. The Stroke Acute Care Research Unit with its stroke team will serve as the focal point for increasing the awareness of physicians of the problems of patients with strokes and how they can be dealt with effectively using the most up-to-date information and methodology. BIBLIOGRAPHIC REFERENCES: Reivich, M., Obrist, W., Slater, R., and Goldberg, H.: A comparison of the Xe133 intracarotid injection and inhalation techniques for measuring regional cerebral blood flow. In: Cerebral blood Flow and Metabolism - Seventh International Symposium Proceedings, (Ed) Harper, M., et al, Churchill Livingstone, Glasgow, (in press). Reivich, M., Obrist, W., Slater, R. and Goldberg, H.I.: Comparison of Xe133 intracarotid injection and inhalation technique. Stroke 6:235, 1975.